SPF 001 010 HMO $75...No. Cantidad Nombre Generico Nombre de Marca Dosis Tamaño Precio E1 Ear Wax...

Name/Nombre: Phone/Teléfono:

Member ID/No de Membresía:

Address/Dirección:

To place your order | Para hacer su pedido:

Monday through Friday | lunes a viernes: 8:00am - 8:00pm

Order Month/Mes de Orden:

SPF 001 (HMO) Miami-Dade CountySPF 010 (HMO) Hillsborough County

Plan:

OTC $75

833-898-7046 / 305-420-3050

No. Qty. Generic Name Brand Name Strength Size CostNo. Cantidad Nombre Generico Nombre de Marca Dosis Tamaño Precio

P1 Acetaminophen Tylenol Extra Strength 500 mg 100 8.00$ P2 Acetaminophen Arthritis Tylenol Arthritis 650 mg 100 10.00$ P3 Aspirin Tablets Ecotrin 325 mg 100 5.00$ P4 Baby Aspirin Baby Aspirin 81 mg 36 4.00$

P5Capsaicin Cream (Arthritis Pain Relief)

Zostrix 0.025 % 2 oz 14.00$

P6 Headache Relief Excedrin 250/250/65mg 100 10.00$ P7 Ibuprofen Advil/Motrin 200 mg 50 5.00$ P8 Icy Hot Medicated Patches Icy Hot* 5% 5 8.00$ P9 Mineral Ice Mineral Ice* 2% 3.5 oz 7.00$ P10 Muscle Rub Ben Gay 15% 3 oz 7.00$ P11 Urinary Pain Relief Azo 95 mg 30 10.00$

Pain Relievers Analgésico

F1 Anti Itch Cream Benadryl Cream 2% 1 oz 6.00$ F2 Bandage Strips Band Aids - 60 5.00$ F3 Calamine Lotion Caladryl 8% 6 oz 6.00$ F4 Cotton Balls Cotton Balls - 100 2.00$ F5 Dimenhydrinate Dramamine 50 mg 12 6.00$ F6 Elastic Bandage (2 or 3 inches) ACE Bandage - 1 7.00$ F7 Hot & Cold Therapy Compress ACE Compress* - 1 14.00$ F8 Hydrocortisone Cream Cortaid Cream 0.5% 1 oz 6.00$ F9 Hydrocortisone Ointment Cortaid Ointment 1% 1 oz 6.00$ F10 Hydrogen Peroxide Hydrogen Peroxide 3% 16 oz 2.00$ F11 Iodine Iodine 2% 1 oz 6.00$ F12 Isopropyl Alcohol Isopropyl Alcohol 70% 16 oz 3.00$ F13 Triple Antibiotic Ointment Neosporin 3.5 mg 1 oz 7.00$

First Aid Primeros Auxilios

H0982_400OTCF752020_C


E1 Ear Wax Drops Debrox 6.5% 0.5 oz 8.00$ E2 Eye Drops Visine 0.05% 0.5 oz 5.00$ E3 Genteal Tears Twin Pack Genteal Tears* 0.1/0.3% 0.5 oz 14.00$ E4 Lutein Plus with Zeaxanthin Lutein Plus with Zeaxanthin 5 mg / 1 mg 60 15.00$ E5 Systane Ultra Systane Ultra* 0.6% 0.3 oz 14.00$

Eye/Ear Care Cuidado de la Vista/OÍdo

L1 Bisacodyl Tablets Ducolax 5 mg 25 6.00$ L2 Docusate Sodium Colace EX 250 mg 100 13.00$ L3 Glycerin Suppositories (adult) Fleet Suppositories 2.1 g 25 5.00$ L4 Natural Fiber Powder Metamucil 3.4 g 13 oz 14.00$ L5 Senna Tabs (Natural Laxative) Senokot 8.6 mg 100 13.00$

Laxatives Laxantes

V1 B12 Sublingual B12 Sublingual 1,000 mcg 100 9.00$ V2 Biotine Biotine 9.00$ V3 Calcium 500 (Oyster Shell) Oscal 500 mg 100 8.00$ V4 Calcium Carbonate + D3 Caltrate + D3 600 mg 60

60

7.00$ V5 Calcium Citrate + D3 Citracal + D3 315 mg 60 7.00$ V6 Co-Enzyme Q10 CoQ10 200 mg 30 21.00$ V7 Daily Multivitamins One A Day Essentials - 100 6.00$ V8 Emergen-C Emergen-C* 1,000 mg 10 8.00$ V9 Epamax Epamax* - 60 15.00$ V10 Fish Oil (Omega-3) Omega-3 1,000 mg 120 9.00$ V11 Folic Acid Folic Acid 800 mcg 100 5.00$ V12 Ginkgo Biloba Ginkgo Biloba 500 mg 60 6.00$ V13 Glucosamine Chondroitin Glucosamine Chondroitin 1,500/1,200 mg 100 18.00$ V14 Gummy Multivitamins One A Day VitaCraves - 50 10.00$ V15 Iron Feosol 65 mg 100 5.00$ V16 Soy Lecithin Soy Lecithin 1,200mg 100 8.00$ V17 Melatonin & B6 Melatonin & B6 5 mg / 1 mg

500/100/40 mg60 7.00$

V18 Menopause Support Caplets Estroven 10.00$ V19 Prostate Therapy Urinozinc - 60 14.00$ V20 Saw-Palmetto Saw-Palmetto 500 mg 60 9.00$ V21 Serenitas (Sleep Aid) Serenitas (Sleep Aid)* - 30

30

15.00$ V22 Veniphlex Veniphlex - 60 17.00$ V23 Vita Trum Centrum Silver - 100 9.00$ V24 Vitamin A 10,000 IU Vitamin A 10,000 IU 3,000 mcg 100 5.00$ V25 Vitamin B Complex Mega B Complex - 100 8.00$ V26 Vitamin C Ascorbic Acid 500mg 100 4.00$ V27 Vitamin D 1,000 IU Vitamin D 1,000 IU 25 mcg 60 7.00$ V28 Vitamin D 2,000 IU Vitamin D 2,000 IU 50 mcg 60 9.00$ V29 Vitamin E 400 IU Vitamin E 400 IU 180 mg 100 7.00$ V30 Vitamin E Oil Vitamin E Oil 3,000 IU 2.5 oz 11.00$ V31 Zinc Sulfate Zinc Sulfate 50 mg 100 7.00$

Vitamins Vitaminas

10,000 mcg

Form A


C1 Acetaminophen Cold Tylenol Cold 325/10/5 mg 24 8.00$ C2 Certizine HCL Zyrtec 10 mg 30 17.00$ C3 Diphenhydramine Capsules Benadryl Capsules 25 mg 24 5.00$ C4 Fexofenadine HCL Allegra 180 mg 15 16.00$ C5 Fluticasone Flonase 50 mcg 120MD 25.00$ C6 Guaifenesin Robitussin 200 mg / 10 ml 4 oz 6.00$

C7Guaifenesin/ Dextromethorphan

Robitussin DM 200-20mg/10 ml 4 oz 7.00$

C8 Loratadine Claritin 10 mg 30 16.00$ C9 Loratadine Syrup Claritin Syrup 5 mg /5 ml 4 oz 10.00$ C10 Medicated Chest Rub Vicks Vapo Rub 4.8% 3.5 oz 7.00$ C11 Mucus Relief Mucinex 400 mg 60 12.00$ C12 Nasal Spray Afrin 0.05% 1 oz 7.00$ C13 Oral Thermometer Thermometer - 1 8.00$ C14 Sea Soft Mist Ocean Saline Nasal Spray 0.65% 1.5 oz 5.00$ C15 Sore Throat Spray Chloraseptic 1.4% 6 oz 6.00$

C16Travel Size Honey Lemon Lozenge

Halls Honey Lemon* 8.8 mg 9 1.00$

C17Travel Size CherryLozenge

Halls Cherry 8.8 mg 9 1.00$

Cough/Cold/Allergy Tos/Resfriado/Alergia

A1 Acid Gone Chewable Gaviscon Chewable 160-105 mg 100 9.00$ A2 Antacid Liquid/ AntiGas Mylanta/Maalox 200/220/20 mg 12 oz 7.00$ A3 Calcium Antacid Tablets Tums EX Assorted 750 mg 96 5.00$ A4 Cimetidine Tablets Tagamet 200 mg 30 11.00$ A5 E�ervescent Pain Relief Alka Seltzer* 1,000/325/1,916 mg 36 6.00$ A6 Gas Relief Simethicone 125 mg 30 7.00$ A7 Mineral Oil Mineral Oil 2.5 ml 16 oz 7.00$ A8 Omeprazole Prilosec 20 mg 14 12.00$ A9 Ranitidine Zantac 75 mg 30 9.00$ A10 Sodium Bicarbonate Sodium Bicarbonate 5 g 100 9.00$

Antacids Antiácido

O1 Cavity Protection Toothpaste Crest Toothpaste* 0.24%

0.07% 250 ml

6.4 oz 4.00$

O2 Denture Cleanser E�erdent - 40 6.00$ O3 Fixodent Adhesive Cream Fixodent Adhesive Cream* - 2.4 oz 6.00$ O4 Mouthwash Crest Mouthwash* 7.00$ O5 Toothbrush Colgate Toothbrush* - 1 3.00$ O6 Total Whitening Toothpaste Colgate Toothpaste*

Floss Picks0.76% 6 oz 5.00$

O7 Floss Picks - 2.00$

Oral Hygiene Higiene Oral

50


N1 Acidophilus with Pectin Acidophilus with Pectin - 100 8.00$ N2 Almebex plus B12 Almebex plus B12* -

-8 oz8 oz

15.00$ N3 Boost (Vanilla or Chocolate) Boost* 15.00$ N4 Meritene Powder Meritene Powder* - 16 oz 16.00$ N5 Probiotic with Veggie Caps Probiotic with Veggie Caps 250 mg 40 15.00$

Nutrition/Digestive Health Nutrición/Salud Digestiva

S1 Calcium Antacid Extra Strength Tums EX Sugar Free 750 mg 80 7.00$ S2 Chromium Picolinate Chromium Picolinate 200 mcg 100 7.00$ S3 Diabetes Trio Diabetes Trio - 60 14.00$ S4 Glucose Tablets Glucose Tablets 4 g 10 4.00$ S5 Guaifenesin SF Robitussin Sugar Free 100mg/5ml 4 oz 8.00$ S6 Irofol Iron Supplement* 100mg/5ml 4 oz 14.00$ S7 SF Natural Fiber Powder Metamucil Sugar Free 3 g 10 oz 12.00$ S8 Tussin DM SF Robitussin DM Sugar Free 200-20mg/10 ml 4 oz 7.00$

Diabetic Section Seccion de Diabéticos

B1 Clotrimazole Cream Lotrim Cream 1% 1 oz 12.00$ B2 Compression Socks (Diabetic) Diabetic Socks - 1 10.00$ B3 Medicated Callus Remover Dr. Scholl's Callus Remover 40% 6 7.00$ B4 Tolnaftate Tinactin 1% 0.5 oz 11.00$

Foot Care Cuidado del Pie

D1 Bismuth Pepto-Bismol 525 mg / 30 ml 8 oz 5.00$ D2 Loperamide Solution Imodium Solution 1 mg / 7.5ml 4 oz 7.00$ D3 Loperamide Tablets Imodium AD 2 mg 12 6.00$

Anti-Diarrheals Antidiarréicos

H1 Hemorrhoidal Ointment Preparation H Ointment 0.25% 2 oz 10.00$ H2 Hemorrhoidal Suppositores Preparation H Suppositores 0.25% 12 8.00$

Anti-Hemorrhoidals Antihemorroidal

I1 Bed Pads Bed Pads - 10.00$ I2 Flushable Wipes Cottonelle Wipes* - 42 5.00$

I3Incontinence Underwear Unisex (S)

Adult Diapers - 19

18

18.00$

I4Incontinence Underwear Unisex (M)

Adult Diapers - 19 18.00$

I5Incontinence Underwear Unisex (L)


I6Incontinence Underwear Unisex (XL)


Incontinence Incontinencia


W1 Clotrimazole Vaginal Gyne-Lotrimin 1% 1.5 oz 13.00$

W2 Miconazole 7 Vaginal Suppositories Monistat Suppositories 100 mg 7 14.00$

W3 Miconazole Vaginal Cream Monistat Cream 100 mg 1.5 oz 15.00$ W4 Tioconazole 1 Tioconazole 7% .16 oz 18.00$

Feminine Hygiene Higiene Femenina

X1Step 1: Nicotine 21mg/24 HR Patch

NicoDerm 21mg/24hr Patch

21 mg 7 40.00$



14 mg 7 40.00$



7 mg 7 40.00$

X4 Step 1: Nicotine 4mg Mint Nicorette 4mg Gum 4 mg 110 40.00$ X5 Step 2: Nicotine 2mg Mint Nicorette 2mg Gum 2 mg 110 40.00$ X6 Step 1: Nicotine 4mg Lozenge Nicorette 4mg Lozenge 4 mg 72 40.00$ X7 Step 2: Nicotine 2mg Lozenge Nicorette 2mg Lozenge 2 mg 72 40.00$

Smoking Cessation Products Productos para dejar de fumar

M1 Antiperspirant Deodorant Dove Original Clean* - 5.00$ M2 Cotton Swabs Q-Tips - 300 3.00$ M3 Fully Automatic BP Monitor Blood Pressure Monitor - 1 35.00$ M4 Gloves Gloves - 6.00$ M5 Hand Sanitizer Purell - 5.00$ M6 Moisturizer Lotion Skin Moisturizer - 10 oz 8.00$ M7 Petroleum Jelly Jar Vaseline Jar* 100% 4.00$ M8 Petroleum Jelly Lip Balm Vaseline Lip Balm* 100% 0.35 oz 2.00$ M9 Salicyclic Acid Compound W Liquid 17% 0.31 oz 11.00$ M10 Shampoo Dove Daily Moisture* - 8.00$ M11 Soap Dove White Bar* - 6.00$ M12 Sunscreen Lotion Banana Boat* SPF 30 7.3 oz 11.00$

Miscellaneous Misceláneo

2.6 oz

508 oz

12 oz

3.75 oz

2.6 oz

DISCLAIMERSolis Health Plans is an HMO with a Medicare contract and a contract with the Florida Medicaid Program. Enrollment in Solis Health Plans, Inc. (HMO) depends on contract renewal.

Atención: Si usted habla español, servicios de asistencia en español, de forma gratuita, están disponible para usted. Llame al 1 (844) 447-6547 (TTY 711)

*Brand Name ProductYou will receive the generic equivalent of all OTC products. The brand that you receive may vary.Usted recibirá el equivalente genérico de todos los productos. La marca que recibirá puede variar.

SPF 001 010 HMO $75...No. Cantidad Nombre Generico Nombre de Marca Dosis Tamaño Precio E1 Ear Wax...

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